HLT-36-12-02010-P and What It Means For NY Physical Therapists

There is a proposed amendment currently scheduled to go into effect on December 1st, 2012 by the New York State Department of Health that should be sounding off loud alarms in therapy practices all over the state. The amendment to Subpart 69-4 of Title 10 NYCCR affects any therapists that take part in the Early Intervention Program. The proposed amendment, HLT-36-12-02010-P, will restrict therapists from providing services for early intervention patients that they have evaluated:

(ii)(a) For children referred to the early intervention program on or after December 1, 2012, or for children referred to the early intervention program prior to December 1, 2012 for whom an additional evaluation or partial evaluation is requested on or after December 1, 2012 for the purpose of adding a new service, neither the evaluator which conducts an evaluation of a child, an approved agency which employs or contracts with the evaluator, nor a relative or business associate of the evaluator, shall provide early intervention services to such child unless authorized by the commissioner, after consultation with the early intervention official, due to special circumstances related to the evaluator's qualifications or availability or other extraordinary circumstances in which there is a clear showing that the child will not be able to access needed services absent such authorization.

This proposal sprung from the assertion by the Department of Health that there is a concern that abuses exist within the system in which EI evaluators may be falsely or erroneously establishing eligibility for patients for financial gain. A concern that has not been formally or publicly identified nor backed up with any supporting data. The Governor of New York commented that "...these regulations will allow the state government to identify and stop the few providers that pocket taxpayer dollars rather than use them to serve the public". The United New York Early Interventions and Pre-School Providers (UNYEIP) submitted a response to the Department of Health that asks some very important questions:

• While parents have always been able to select their evaluator, it has been an accepted assumption since the inception of Early Intervention in nearly ALL circumstances in NYC and in other municipalities that also have Provider-Agencies, where agencies provide both evaluations and service, that the evaluating agency will also provide the services. Why does the DOH want to change this procedure when in fact it will only end up further burdening our families and introducing a barrier to care?
• The NYS representative EIO authorizes ALL Early Intervention service authorizations and, thereby, provides a LARGE checks and balances. Is the state suggesting that EIO’s are culpable in contributing to a Conflict of Interest. EIO’s are the single most responsible individual in this decision-making process. Is the state prepared to point a finger at these state employees to determine and communicate their role in this conflict of interest? What training will be provided to EIO’s in this regard?
• Will costly “Conflict of Interest” issues manifest in other ways that are invisible, not data-trackable that can not either manifest or be minimized by disclosures.
• Who will this Conflict of Interest benefit? The Children? The Families? The Providers: Large Agencies? Small Therapist-Owned Agencies? Independent Contractors? Out-of-State Based Agencies? In-State Based Agencies? The State? Evaluating Agencies? Treatment Agencies?

The New York Association of Physical Therapists (NYPTA) has also reached out to the Department with a list of their concerns should this amendment go into effect:

• Regulations restrict parental choice: The regulations will reduce the number of approved evaluators in all settings particularly rural settings
• Regulations will limit small business participation in the early intervention program
• Prohibition will restrict access to services in rural settings
• Proposed prohibition is inconsistent with the practice of physical therapy: The evaluative process and the provision of services is intertwined particularly in the very young served by the early intervention program.

Many therapists strongly feel that the ramifications of implementing this amendment are going to be deeply affect not only themselves, but also the families they are devoted to helping. The state's proposal seems to be a case of finding the easiest solution rather than the smartest one. By eliminating the option of both evaluating and providing EI services, the state frees itself from having to collect and manage data or to holding those who manipulate the system accountable. And is to do all this to prevent the perceived "few providers" really necessary? Regulations are important in maintaining checks and balances to ensure that public funds are spent wisely. But at what point do those regulations come full circle and actually do harm to the very public whose funds they are claiming to protect? Do you have an opinion on this proposal? Have you already spoken out about it?